Impairment In Activities Of Daily Research Articles

PCR137 Work Productivity and Activity Impairment in Patients with Severe Asthma Treated with Mepolizumab in a Real-World Setting

Severe asthma is associated with substantial productivity loss and activity impairment. In the real-world REALITI-A study, mepolizumab reduced clinically significant exacerbations and oral corticosteroid use in patients with severe asthma. Although mepolizumab improved activity impairment and work productivity in clinical trials, real-world data are limited. This post hoc analysis assessed the real-world impact of mepolizumab treatment on work productivity and daily activity impairment.

A study to investigate the prevalence of headache disorders and migraine among people registered in a health insurance association in Japan

BackgroundMigraine is a chronic disease characterized by episodic headache attacks. No recent studies have, however been conducted on the epidemiology of migraine or the treatment landscape in Japan. This study was conducted as a fact-finding survey using medical claims data and an online survey on migraine and headaches, conducted among members of health insurance associations with the objective of gaining an understanding of migraine prevalence and the treatment status in Japan.MethodsThe study methodology utilized a unique approach of combined data sources. The data sources used in this study are medical claims data and linked online survey data provided by DeSC Healthcare Inc (DeSC). The primary outcomes (from survey responses) were: the overall number and proportion of migraine patients; and the overall prevalence of migraine, stratified by age and sex. The secondary outcomes (from survey responses) were use of medical care; and clinical features/headache symptoms. The analysis population included all individuals who had response data for surveys conducted by DeSC. The online survey data and medical claims data were summarized.ResultsThe data population comprised 21,480 individuals. On the basis of the survey results, including probable cases, the overall prevalence of migraine was 3.2%. The highest prevalence of migraine was observed in patients aged 30–39 years. The prevalence of migraine in women was 4.4 times higher than in men. The percentage of migraine patients who had not been seen by a doctor was 81.0%. More than 80% of patients were taking over-the-counter drugs and 6.1% took prescription medicines only. Approximately 52.9% of patients considered that the intensity of pain symptoms was severe. Moreover, the majority of patients (72.9%) considered that the impairment of daily life activities was of moderate or severe degree.ConclusionsIn Japan, the percentage of people with migraine who did not receive medical attention is as high as 80%. Additionally, the majority of patients tend to endure symptoms and continue with everyday activities. With innovative treatment approaches becoming available it is necessary to disseminate information that migraine is not a simple headache but an illness that requires medical treatment and consultation.

The effect of hypocalcemia on motor symptoms of Parkinson’s disease

BackgroundThe disabling nature of Parkinson’s disease (PD) impairs functional mobility and worsens quality of life. Calcium imbalances are thought to have a significant role in the progression of PD.ObjectiveTo evaluate the relation between calcium deficiency and deterioration of PD motor symptoms.MethodsA total of 28 idiopathic PD patients were subjected to motor symptoms evaluation using the modified Hoehn–Yahr scale (H–Y), Unified Parkinson’s Disease Rating Scale (UPDRS) Part II and III and Schwab and England Activities of Daily Living Scale (S–E ADL). Total and ionized serum calcium levels were measured for the PD patients and the 30 healthy control subjects.ResultsThe level of ionized calcium was significantly lower among PD patients (4.19 mg/dl ± 0.53) than in control subjects (4.8 mg/dl ± 0.35) (p < 0.0001). The PD patients with hypocalcemia showed marked deterioration of motor symptoms and significant impairment of daily life activities when compared to PD patients with normal calcium levels regarding their scores on the modified H–Y scale (p = 0.001), UPDRS-III (p = 0.001), UPDRS-II (p = 0.001), and S–E ADL scale (p = 0.001). Ionized calcium correlated significantly with PD patients’ scores on the modified H–Y scale (p = 0.019), UPDRS-Part II (p = 0.001), UPDRS-Part III (p = 0.001) and S–E ADL scale (p = 0.001). The significant cutoff point of the ionized calcium for detection of the deteriorated PD patients that presented with stages more than grade 2 of the modified H–Y scale was < 3.99 (p = 0.037) with a sensitivity of 80% and specificity of 95%.ConclusionsOur findings conclude that calcium deficiency could contribute to the deterioration of PD motor symptoms.

Immune Cell Infiltration Characteristics of Pigmented Villous Nodular Synovitis and Prediction of Potential Diagnostic Markers Based on Bioinformatics

Background Pigmented villous nodular synovitis (PVNS) is a tumor-like proliferative disease characterized by impairment of daily activities, decreased quality of life, and a high recurrence rate. However, the specific pathological mechanisms are still ill-defined and controversial. The purpose of this study was to define potential diagnostic markers and evaluate immune cell infiltration in the pathogenesis of PVNS. Method The expression profile of GSE3698 was reanalyzed in the Gene Expression Omnibus (GEO) database. First, differentially expressed genes (DEGs) were identified using the R package “limma” and analyzed by Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. Next, the DEGs were imported into the STRING database and Cytoscape to construct a protein–protein interaction (PPI) network. Then, cytoHubba and ROC curve analyses were used to determine potential diagnostic biomarkers of PVNS. Finally, we used CIBERSORT to estimate the proportions of 22 immune cell subtypes in PVNS and analyzed the correlation between diagnostic markers and infiltrating immune cells. Result We found 139 DEGs (including 93 upregulated genes and 46 downregulated genes). TYROBP, FCER1G, LAPTM5, and HLA-DPB1 were identified as potential diagnostic biomarkers of PVNS. Immune cell infiltration analysis indicated that neutrophils and M2 macrophages might be associated with the genesis and progression of PVNS. Furthermore, our correlation analysis of diagnostic markers and infiltrating immune cells found that TYROBP, FCER1G, LAPTM5, and HLA-DPB1 were positively correlated with M2 macrophage infiltration and that neutrophils, TYROBP, FCER1G, and LAPTM5 were negatively correlated with plasma cell infiltration. Conclusions We identified TYROBP, FCER1G, LAPTM5, and HLA-DPB1 as potential diagnostic markers for PVNS and concluded that immune cell infiltration plays an important role in the genesis and progression of PVNS.

Visualization of the location and level of pain in common wrist pathologies using color-coded heatmaps

BackgroundPain of the hand and wrist affects a large patient population. If the onset is unrelated to recent trauma, the first medical contact is rarely established with a specialized hand surgeon.ObjectiveThe objective of this investigation was to (1) visualize the localization of hand pain using pain-related heatmaps in common wrist pathologies, (2) to test whether differences between these pathologies exist with regard to sociodemographic and pain-related aspects, and (3) to evaluate the major patient-reported complaints associated with the pathologies.MethodsThis observational cross-sectional study included patients suffering from: thumb basal joint arthritis (CMC-1-OA), dorsal wrist ganglions, and TFCC tears. Patients marked the location of maximum pain projection on hand graphics depicting the outline of the palmar and dorsal hand. Color-graded frequency heat maps were generated for the wrist pathologies investigated. Daily life impairments were assessed and clustered into groups of functions/activities.Results120 patients with a mean age of 44.3 years were investigated. The diagnostic groups showed significant differences regarding the level and location of pain, as well as daily life impairments. Patients with CMC-1-OA presented with increased pain levels compared to patients with dorsal wrist ganglions and TFCC tears. Daily life impairment was rated highest when household chores were adversely affected, and sport activities were symptomatic/painful. All groups showed significant skin surface pain projection, which was visualized in heatmaps. While general trends in pain localization were visible, pain levels were also reported distal/proximal and palmar/dorsal to the pathology.ConclusionsKnowledge of main demographic parameters, pain projection, and degree of impairment in daily activities can help physicians to narrow differential diagnosis of wrist pain during first patient contact. Patients should then be referred to hand surgeons for specialist examination, to further differentiate the origin of the pain.

A Prospective Study to Evaluate the Impact of Golimumab Therapy on Work Productivity and Activity, and Quality of Life in Patients With Rheumatoid Arthritis, Psoriasis Arthritis and Axial Spondyloarthritis in a Real Life Setting in AUSTRIA. The GO-ACTIVE Study.

ObjectiveTo analyze real-world evidence on work productivity and daily activity impairment (WPAI) and health-related quality of life (HRQoL) in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) patients treated with golimumab in Austria.MethodsThis was a prospective, non-interventional, multi-center study conducted in RA, PsA and axSpA patients initiating golimumab between April 2016 and May 2020 in 40 centers in Austria. WPAI, HRQoL (RAQoL, ankylosing spondylitis (AS)QoL and PsAQoL) questionnaires and disease activity (Clinical Disease Activity Index, CDAI, in RA and PsA; Bath Ankylosing Spondylitis Disease Activity Index, BASDAI, in axSpA) were assessed at baseline and months 3, 6, 12, 18, and 24. Association between WPAI and disease activity was tested using linear regression.ResultsWe enrolled 233 patients (RA, n = 95; axSpA, n = 69; PsA, n = 69), 110 patients were followed up to month 24. Mean age was 50.2 ± 14.2 years; 64% were female. Disease activity decreased from baseline to month 24 (RA: CDAI −24.3 ± 13.5; axSpA: BASDAI −4.4 ± 2.1, and PsA: CDAI −21.7 ± 8.5, p < 0.0001, each). Total work productivity impairment (TWPI), activity impairment and presenteeism subscores continuously decreased throughout month 24 in all indications: RA (−58.3 ± 23%, −62.6 ± 23.8% and −61.7 ± 23.3%, respectively as compared to baseline; p < 0.0001, each), axSpA (−34.4 ± 38.3%, p = 0.0117; −60.9 ± 25.9%, and −43.8 ± 26.6%, respectively, p ≤ 0.0001 both) and PsA (−35.8 ± 43.7%, p = 0.0186; −52.3 ± 25.4%, p < 0.0001; and −43.3 ± 33.5%, p = 0.0007, respectively). Absenteeism scores decreased only in RA patients (−9.2 ± 24.9%, p = 0.0234). HRQoL improved between baseline and month 24 (RAQoL: −12.6 ± 7.5; ASQoL: −8.0 ± 4.3; PsAQoL; −8.3 ± 6.4, p < 0.0001, each). TWPI, presenteeism and activity impairment strongly associated with disease activity throughout the study.ConclusionsThis real-world study confirms the benefit of golimumab on work productivity/daily activity impairment in Austrian RA, PsA, and axSpA patients.

A STUDY OF EXECUTIVE FUNCTIONS IN RIGHT HEMISPHERIC STROKES

Introduction: Stroke is a leading cause of disability worldwide. Cognitive functions and, in particular, executive function is commonly affected after stroke, leading to impairment in daily activities. Previous studies have shown conicting evidence regarding the incidence of executive dysfunction in patients with right or left hemispheric strokes. Few studies have shown that executive dysfunction is more prevalent in right hemispheric strokes. Aims and Objectives: 1. To study the executive dysfunction in patients with Right Hemispheric strokes. 2. To compare the impairment of executive functions with the Vascular territory involved Methods: This was a prospective observational study which included 100 patients admitted to a tertiary care center from January 2021 to August 2021. After Institutional EC clearance, patients with Right-Hemispheric ischemic stroke on neuro-imaging (CT or MRI) were included in the study. Demographic data, clinical history, neurological examination and etiological workup like echocardigraphy, carotid and vertebral artery doppler, CT/MR angiography were performed. Executive function was tested clinically using go-no-go test, digit-span test, trail making test, N-back test, Rey-osterreith complex gure test and clock drawing test. Data was entered to a pre-formatted data sheet and analysed. Results: The mean age of the included patients was 58.76years, 54 patients were male, Sixty-nine patients had anterior circulation stroke, 31 had posterior circulation stroke. Forty three patients had executive dysfunction as evidenced by abnormal go-no-go test (n=22), digit-span test(n=35), trail making test(n=10), N-back test(n=23), Rey-osterreith complex gure test(n=38) and clock drawing test(n=29). Executive dysfunction was more prevalent in anterior circulation strokes (n=37) as compared to posterior circulation strokes (n=6) (p=0.001) Executive dysfunctionConclusion: was a common nding in patients with right hemispheric stroke and was signicantly higher in patients with anterior circulation strokes.

Improvement of Work Productivity and Quality of Life with Anti-Tumor Necrosis Factor Treatment Used in Crohn's Disease in Routine Clinical Practice in Turkey.

Patients with Crohn's disease experience major deterioration in work productivity and quality of life. We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36. Patients with Crohn's disease and initiated an anti-tumor necrosis factor treatment were included and followed up for 12 months in this observational study. A total of 106 patients were included in this study, and 64.2% of the patients were males. Mean [± standard deviation] age was 36.8 [± 10.9] years. At baseline, mostly perianal fistulas [65.7%] were observed [n = 23]. Intestinal stenosis was detected in 34.9% of the patients [n = 37], and most of the stenosis was located in the ileum [70.6%] followed by the colon [20.6%]. Extraintestinal symp- toms were observed in 24 patients [22.6%]. Most frequent extraintestinal symptom was arthritis with 71.4% [n = 15]. Mean time from first symptom to initiation of anti-tumor necrosis factor treatment was 6.3 [± 5.0] years. Improvements in work productivity and activ- ity impairment scores throughout 12 months were -24.1% [P = .003] for work time missed, -18.0% [P = .006] for impairment at work, -8.5% [P = .160] for overall work impairment, and -17.0% [P < .001] for daily activity impairment. Similarly, significant improvements [P < .001] were detected in all components of the Inflammatory Bowel Disease Questionnaire when compared to baseline. Statistically sig- nificant improvements [P < .05] were detected for all components of Short-Form Health Survey-36 except for mental health [P = .095]. Our study indicates the significant improvement in work productivity and activity impairment and quality of life of patients with Crohn's disease who receive long-term anti-tumor necrosis factor treatment.

Clinical and humanistic burden among pediatric patients with neurofibromatosis type 1 and plexiform neurofibroma in the USA

PurposeTo assess clinical and humanistic burden among pediatric patients with neurofibromatosis type 1 (NF1) and plexiform neurofibroma (PN) in the USA.MethodsNF1-PN patients aged 8–18 years (treatment-naïve or ≤ 1 month of selumetinib treatment) and their caregivers and caregivers of similar patients aged 2–7 years were recruited through the Children’s Tumor Foundation to participate in an online cross-sectional survey (December 2020–January 2021). Caregivers provided data on patients’ demographic and clinical characteristics and burden of debulking surgeries. Patients and caregivers provided self-reported or proxy responses to health-related quality of life (HRQoL) questions using validated instruments.ResultsSixty-one patients and 82 caregivers responded to the survey. Median (range) age of patients was 11.5 (3–18) years, and 53.7% were female. Most were treatment-naïve (97.6%), with NF1-PN diagnosis for > 5 years (68.3%). Most patients (59.8%) had > 1 PN and 11.0% reporting > 5 PNs. Common NF1-PN symptoms included pain (64.6%), disfigurement (32.9%), and motor dysfunction (28.0%). Patients and caregiver proxies reported low overall HRQoL and reduced physical, emotional, social, and school functioning. Patients also reported considerable pain severity, interference, daily activity impairments, and movement difficulty. Few patients had received complete resections of their tumors (12.2%). 39.0% reported ≥ 1 debulking surgery, among whom, 15.6% had complications, and debulking surgery-related hospitalizations were common (53.1%).ConclusionsThe clinical and humanistic burden among pediatric NF1-PN patients is substantial. While debulking surgeries are used for symptom management, they are associated with considerable clinical sequelae. Results highlight a need for improved disease management strategies.

Chronic cough in asthma is associated with increased airway inflammation, more comorbidities, and worse clinical outcomes.

Background: Cough is often the most prominent and intractable symptom reported by patients with asthma, but few studies have explored the characteristics of patients with asthma and with chronic cough (CC) in a real-world setting. Methods: In a prospective cohort study, patients ages ≥ 18 years with stable asthma were consecutively recruited at the West China Hospital, Sichuan University. The patients were classified as having asthma with CC (the CC group) or asthma with non-CC (the non-CC group) after 3 months of optimized asthma therapy according to standard guidelines. Multidimensional assessment was performed at baseline, followed by a 12-month follow-up to assess asthma exacerbations. Results: Of 323 patients with asthma, 127 patients were assigned to the CC group and 196 patients were assigned to the non-CC group. The participants with CC were older and had more airflow obstruction; worse asthma control and quality of life; increased airway inflammation; upper respiratory tract infection as a trigger; and more comorbidities, such as psychological dysfunction, rhinitis, chronic obstructive pulmonary disease, and bronchiectasis. They reported greater work productivity loss and daily activity impairment, and increased moderate-to-severe exacerbations. Conclusion: The participants with asthma and with CC had a significant disease burden, with increased exacerbations, health-care utilization, and impaired work productivity and daily activity. These observations indicated potential clinical implications in patients with asthma and with CC, and call for more attention to this aspect of asthma.

How Well Does Patient-reported Functional Disability Correspond to Measures of Physical Fitness in Adolescents with Fibromyalgia?

The Functional Disability Inventory (FDI) is one of the most commonly used patient-reported outcome measures in clinical trials of pediatric pain. In addition to self-reported impairment, studies using activity monitoring devices show that adolescents with widespread musculoskeletal pain often exhibit sedentary behavior. Little is known about how impairment in daily physical activities is reflected in objectively-assessed physical fitness among adolescents with widespread pain. During a baseline assessment for a clinical trial, adolescents with juvenile fibromyalgia (N=226, Mage=15.26, 85% female) completed questionnaires (FDI, PROMIS-Fatigue, pain intensity VAS) and two validated assessments of physical functioning (The Harvard Step Test [HST], a test of aerobic fitness; and the Six-Minute Walk Test [6MWT], the distance a participant is able to walk in 6 minutes). We hypothesized that measures of physical fitness would predict variance in self-reported physical functioning (FDI scores) after controlling for pain and fatigue. We computed bivariate correlations followed by a hierarchical linear regression analysis with pain intensity and fatigue entered in the first step, fitness assessments in the second step, and FDI scores as the dependent variable. FDI scores were strongly associated with fatigue and pain levels (r=.55, p<.001 and r=.47, p<.001, respectively), but only modestly associated with HST (r=-.29, p<.001) and 6MWT scores (r=-.16, p=.02). In the regression model, pain and fatigue together explained 59% of the variance in FDI scores, while fitness measures explained only 2% unique variance (∆r2=.02, p=.07). HST significantly predicted FDI scores (β=-.16, t=-2.21, p=.03), but 6MWT distance did not. After controlling for pain intensity and fatigue, only the HST showed a significant relationship to self-reported functional disability. Overall, fitness measures contributed negligibly to FDI scores. Results support the need to examine cognitive and emotional factors (e.g., fear of movement) which may contribute to physical impairment among youth with chronic pain. Grant support from NIAMS/NIH R01 AR070474 (PI: Kashikar-Zuck).

COVID-19 mortality and its predictors in the elderly: A systematic review.

Background and AimsOlder people have higher rates of comorbidities and may experience more severe inflammatory responses; therefore, are at higher risk of death. Herein, we aimed to systematically review the mortality in coronavirus disease 2019 (COVID‐19) patients and its predictors in this age group.MethodsWe searched PubMed, Web of Science, and Science Direct using relevant keywords. Retrieved records underwent a two‐step screening process consisting of title/abstract and full‐text screenings to identify the eligible studies.ResultsSummarizing findings of 35 studies demonstrated that older patients have higher mortality rates compared to the younger population. A review of articles revealed that increasing age, body mass index, a male gender, dementia, impairment or dependency in daily activities, presence of consolidations on chest X‐ray, hypoxemic respiratory failure, and lower oxygen saturation at admission were risk factors for death. High d‐dimer levels, 25‐hydroxy vitamin D serum deficiencies, high C‐reactive protein (≥5 mg/L) levels plus any other abnormalities of lymphocyte, higher blood urea nitrogen or lactate dehydrogenase, and higher platelet count were predictors of poor prognosis and mortality in the elderly. Studies have also shown that previous treatment with renin–angiotensin–aldosterone system inhibitors, pharmacological treatments of respiratory disorders, antibiotics, corticosteroids, vitamin K antagonist, antihistamines, azithromycin, Itolizumab (an anti‐CD6 monoclonal antibody) in combination with other antivirals reduces COVID‐19 worsening and mortality. Vaccination against seasonal influenza might also reduce COVID‐19 mortality.ConclusionOverall, a critical consideration is necessary for the care and management of COVID‐19 in the aged population considering the drastic contrasts in manifestation and prognosis compared to other age groups. Mortality from COVID‐19 is independently associated with the patient's age. Elderly patients with COVID‐19 are more vulnerable to poor outcomes. Thus, strict preventive measures, timely diagnosis, and aggressive therapeutic/nontherapeutic care are of great importance to reduce acute respiratory distress syndrome and severe complications in older people.

High Impact of Pediatric Inflammatory Bowel Disease on Caregivers’ Work Productivity and Daily Activities: An International Prospective Study

To evaluate the longitudinal evolution of work productivity loss and activity impairment in caregivers of children with inflammatory bowel disease (IBD). We also evaluated the associations between these impairments, IBD-related factors, and caregivers' health-related quality of life (HRQOL) and estimated the indirect costs related to work absenteeism. Since January 2017, children with newly diagnosed IBD were enrolled prospectively in the Pediatric Inflammatory Bowel Disease Network for Safety, Efficacy, Treatment and Quality improvement of care study. The impact of pediatric-onset IBD on caregivers' socioeconomic functioning (work and daily activities) and HRQOL was assessed using the Work Productivity and Activity Impairment for caregivers questionnaire and the European Quality of Life Five Dimension Five Level questionnaire, at diagnosis and 3 and 12months of age. Generalized estimating equation models were applied to evaluate outcomes longitudinally, adjusted for IBD type, disease activity, and child's age at diagnosis. Up to July 2021, 491 children with IBD were eligible for analysis of caregivers' Work Productivity and Activity Impairment questionnaire. At diagnosis, the mean caregivers' employment rate was 78.4%; the adjusted mean work productivity loss was 44.6% (95% CI, 40.2%-49.0%), and the adjusted mean activity impairment was 34.3% (95% CI, 30.8%-37.7%). Work productivity loss and activity impairment significantly decreased over time and were associated with disease activity, but not with IBD type or child's age. Caregivers' HRQOL was associated with both impairments. Costs related to work absenteeism were at least €6272 ($7276) per patient during the first year after diagnosis. Caregivers of children with IBD experience significant impairments in work and daily activities, especially at diagnosis. The impact decreases thereafter and is associated with disease activity and caregivers' HRQOL. Work absenteeism results in high indirect costs.

Improvements in itch and sleep following treatment with baricitinib in combination with topical corticosteroids are associated with better quality of life and productivity in adult patients with moderate-to-severe atopic dermatitis: a post hoc analysis from BREEZE-AD7

Treatment with baricitinib in combination with topical corticosteroids previously showed greater improvements in itch and sleep versus placebo in adults with moderate-to-severe AD. To assess whether improvements in itch and sleep translate to greater quality of life (QoL), productivity and treatment benefit in AD. In this post hoc analysis with data from BREEZE-AD7 (NCT03733301), itch and sleep improvements at Week 16 were defined by ≥4-point improvements in the Itch Numeric Rating Scale and ≥1.5 decreases in the number of night-time awakenings since baseline, respectively. Dermatology Life Quality Index, Work Productivity and Activity Impairment-AD and Patient Benefit Index (PBI) scores were compared in patients with and without improvements. Proportions were analysed using logistic regression with non-responder imputation. Changes from baseline were calculated using ANCOVA, with last observation carried forward. Least square mean PBI scores were assessed using ANOVA. More patients with itch improvement versus no itch improvement reported no impact of AD on QoL (28.4% vs. 6.0%). Daily activity impairment was lower in patients with itch improvement (-39.6% vs. -15.6%). A greater proportion of patients with sleep improvement versus no sleep improvement had no AD-related impact on QoL (24.1% vs. 1.5%). Patients with sleep improvement had less daily activity impairment (-35.0% vs. -18.5%). Patients with itch and sleep improvements experienced greater treatment benefit. Patients with AD who experienced clinically meaningful improvements in itch and sleep following treatment had significantly better QoL, productivity and treatment benefit. Addressing these symptoms is important to achieving meaningful and patient-relevant improvements in well-being.

Lactobacilli reduce recurrences of vaginal candidiasis inpregnant women: a randomized, double-blind, placebo-controlled study.

The aim of this study was to investigate the effects of lactobacilli strains in preventing the recurrences of vaginal candidiasis (VC) in 78 pregnant women with VC (lactobacilli, n=39; placebo, n=39) and the potential benefits on quality of life. The lactobacilli putative probiotic (SynForU-HerCare; two capsules/day of 9·5 log CFU per capsule) or placebo was administered for 8-weeks in a randomized, double-blind, placebo-controlled study. Subjects were assessed for vaginal and gut health conditions at baseline, week-4 and week-8 via questionnaires. The vulvovaginal symptom questionnaire not only covered aspects pertaining to vulvovaginal symptoms but also the quality of life impacts such as emotional, social and sexual. The administration of lactobacilli reduced symptoms of irritation (P=0·023) and discharge (P=0·011) starting week-4 and continued after week-8 (P<0·05), accompanied by reduced symptoms for burning after week-8 (P=0·046) as compared to the placebo. Patients consuming lactobacilli also showed reduced concern about symptoms after week-4 (P=0·010) and continued after week-8 (P=0·001), accompanied by reduced impairment of daily activities attributed to vulvovaginal symptoms (P=0·012) and continued after week-8 (P=0·026). Insignificant differences were observed for sexual impacts between treatment groups. The administration of lactobacilli also reduced recurrences of both emotional and social stress as compared to the placebo at both week-4 and week-8 (P<0·05). Patients consuming lactobacilli showed higher defecation times per week at week-4 (P=0·010) and week-8 (P=0·001) as compared to the placebo group, indicating the potential to reduce risks of pregnancy-induced constipation. Lactobacilli probiotics are beneficial towards pregnant women, especially in reducing vulvovaginal symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC. The study demonstrated the preventive and modulatory roles of lactobacilli strains against VC in pregnant women. Taken altogether, our present data illustrated that lactobacilli probiotics are beneficial towards pregnant women, especially in reducing vulvovaginal symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC, thus could be a potential strategy for the maintenance of vaginal health during pregnancy.

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

Quality of life and informal care burden associated with duchenne muscular dystrophy in Portugal: the COIDUCH study

BackgroundTo describe the reduced health-related quality of life (HRQoL) of duchenne muscular dystrophy (DMD) patients and their caregiver burden and to present its relationship with disease progression.MethodsThis cross-sectional study assessed patient HRQoL with the 3-level version of the EuroQol-5D (EQ-5D-3L) and caregiver burden with the Work Productivity and Activity Impairment: General Health questionnaire. DMD patients and their caregivers were identified through Portuguese Neuromuscular Association (APN).ResultsA total of 46 DMD main caregivers, of eight ambulant and 38 non-ambulant patients, completed the questionnaires. Over half (58.7%) of all non-ambulant patients were on ventilation support, either full-time (15.2%) or non full-time (43.5%). Non-ambulant patients had a lower mean utility scores than ambulant patients (− 0.05 versus 0.51, p value < 0.001). Caregivers of non-ambulant patients reported a significant mean daily activity impairment as compared to caregivers of ambulant patients (68% versus 23%, p value < 0.001). Among non-ambulant patients, both utility scores and caregiver impairment appeared to deteriorate according to a higher need for ventilation support, however, these results were not statistically significant.ConclusionsThese results emphasise the significant negative impact that DMD progression has on the patient HRQoL, as well as caregivers’ ability to conduct their daily activities. Therapeutic options that stop or slow the disease progression could have a beneficial impact for both patients and caregivers.

Circulating inflammatory monocytes oppose microglia and contribute to cone cell death in retinitis pigmentosa.

Retinitis pigmentosa (RP) is an intractable inherited disease that primarily affects the rods through gene mutations followed by secondary cone degeneration. This cone-related dysfunction can lead to impairment of daily life activities, and ultimately blindness in patients with RP. Paradoxically, microglial neuroinflammation contributes to both protection against and progression of RP, but it is unclear which population(s) - tissue-resident microglia and/or peripheral monocyte-derived macrophages (mφ) - are implicated in the progression of the disease. Here we show that circulating blood inflammatory monocytes (IMo) are key effector cells that mediate cone cell death in RP. Attenuation of IMo and peripherally engrafted mφ by Ccl2 deficiency or immune modulation via intravenous nano-particle treatment suppressed cone cell death in rd10 mice, an animal model of RP. In contrast, the depletion of resident microglia by a colony-stimulating factor 1 receptor inhibitor exacerbated cone cell death in the same model. In human patients with RP, IMo was increased and correlated with disease progression. These results suggest that peripheral IMo is a potential target to delay cone cell death and prevent blindness in RP.

Neurofibroma of the Median Nerve Managed With Ultrasound Guided Nerve Block: A Case Report

Background: Median nerve neurofibroma can mimic carpal tunnel syndrome. In unilateral carpal tunnel syndrome, wrist imaging is suggested to exclude tumors. Diagnosis and management of peripheral nerve sheath tumors can be challenging.&#x0D; Case: This is a case report of 42-year-old female with median nerve neurofibroma who presented with excruciating pain as the main symptom. Though surgical excision is the preferred treatment, it is associated with the risk of functional deficit. In this case, patient was unwilling for surgery. This report highlights the evaluation of neurofibroma and the role of median nerve block in the symptomatic as well as functional improvement.&#x0D; Conclusion: Nerve block can be effective if neurofibroma presents with pain as the main symptom without any impairment of motor function or daily activities.

Association Between Serum Vitamins and the Risk of Alzheimer's Disease in Chinese Population.

Alzheimer's disease (AD) is a chronic and fatal neurodegenerative disease; accumulating evidence suggests that vitamin deficiency is associated with the risk of AD. However, studies attempting to elucidate the relationship between vitamins and AD varied widely. This study aimed to investigate the relationship between serum vitamin levels and AD in a cohort of the Chinese population. A total of 368 AD patients and 574 healthy controls were recruited in this study; serum vitamin A, B1, B6, B9, B12, C, D, and E were measured in all participants. Compared with the controls, vitamin B2, B9, B12, D, and E were significantly reduced in AD patients. Lower levels of vitamin B2, B9, B12, D, and E were associated with the risk of AD. After adjusting for age and gender, low levels of vitamin B2, B9, and B12 were still related to the risk of AD. In addition, a negative correlation was determined between vitamin E concentration and Activity of Daily Living Scale score while no significant association was found between serum vitamins and age at onset, disease duration, Mini-Mental State Examination, and Neuropsychiatric Inventory Questionnaire score. We conclude that lower vitamin B2, B9, B12, D, and E might be associated with the risk of AD, especially vitamin B2, B9, and B12. And lower vitamin E might be related to severe ability impairment of daily activities.